Reflections of a physiotherapist in 2015

The end of another year is a chance to reflect, on life, work, goals for the future etc.


I started to think about all the courses and conferences I’ve been on, articles I’ve read, blogs and tweets I’ve seen, and I have to say I’m a tad confused, but also sadly worried!


As some background to me… I’m a South African physio who studied physiotherapy in my home country (graduating 2001), and then later on did a masters degree in Manual Therapy in Australia. I’ve worked 7 years full time in professional and international sport as team physio, and consulted thereafter to various sports. I now run a busy private practice in the UK but I work full time as a clinician. I would call myself a ‘hands-on-physio’ and up until recently I didn’t realise that was becoming a very much frowned upon thing to be. I also spend a lot of time with patients doing rehab exercises both in the clinic and the gym, and sometimes when I’m lucky enough to have the time, in their sporting environment.

SASMA Conference 2015

So back to the confusion: I went to one sports medicine conference in South Africa this year where the international lecturers spoke extensively about the use of manual therapy, demonstrated various techniques, explained that mechanotransduction takes place through exercise as well as handling of tissues. Taping methods were demonstrated. There was discussion about the use of dry needling/ acupuncture. There was extensive discussion about return to sport rehab exercises. There has also been a LOT of talk about fascia, at pretty much every conference I’ve been to for the last five years. Definitely the latest trend, and yes, it has been pointed out that fascia is exceptionally strong and we couldn’t hope to alter the structure of it. But manual therapists around the world are teaching fascial stretching and/ mobilisation techniques, and obviously they’re not affecting what they think they are affecting, but they must be doing something, or is this the biggest case ever of the ‘king’s clothing’? Do we just not yet understand the mechanisms of whatever people are doing to the tissue? Should we throw it out as the science hasn’t proven the method, or should we continue to practice the method to improve our skills at it, and hope that science catches up with us to explain why? I’m asking the question, and I don’t know the answer, other than how else do we learn?

Therapy Expo 2015

The next conference I went to was in the UK, a conference directed mainly at therapists. It very much reflected the trend certainly in the UK that ‘hands-off’ physio is the way people are moving. We are encouraged not to talk about pathology, as this can lead to chronic pain behaviour and delay healing. Now in certain parts of the population, this is exceptionally relevant. However, if you have a young sportsman who is virtually impossible to slow down, do we not want them to know that there is injured tissue? Do we not need them to realise the consequences of pushing on? I know that imaging does not equal pathology and visa versa but sometimes there IS pathology, and surely its best for the patient to understand it? For me there is nothing worse than another therapist in my clinic seeing a patient of mine and telling them all the things that are ‘wrong’ with them. What a nightmare when I’ve been building them up through their rehab! But equally, shouldn’t we be empowering patients to assist with their own condition when they fully understand what they are dealing with. There is also a strong push for patients not to be reliant on their ‘healing therapist’s hands’ which is music to all of our ears. But recently I saw a comment on social media when someone asked a physiotherapist if they would manip a joint which would help the painful area and the therapist responded with ‘I have better things to spend my time on’. Now this is possibly true, but are we not allowed to help make people feel better? I like to help people leave my rooms feeling like I have had an effect on the injured area, and while doing my evil ‘hands-on-treatment’ which god forbid makes them feel a little easier, we discuss what the plan is going forward, and then we work on the exercises they’re going to do, and I explain that should they not keep up their end of the bargain (their homework), whatever perceived ‘gains’ we have from the treatment will disappear as quickly as they have arrived. Personally I have tried to rehab an extremely serious injury with only exercise, and only after months and months of struggling on my own did I relent, make time, and get some help from a colleague, and the change was almost instantaneous! A little bit of hands on help in conjunction with what I was doing was the game changer.

There are obviously huge psychological issues involved with many patients, but often the ‘hands-on’ time allows us some insight into these issues, and although we are not psychologists, and I never even begin to say that we should act as such as it is far beyond our scope of pratice, sometimes the simple act of being able to tell someone what is most bothering you, often makes you feel better. If someone is in pain, is it not our duty to assist? And if beyond our scope to make appropriate onward referral?


Possibly the most disappointing thing I feel about the way in which our profession, certainly in the UK, is moving, is the disparagement of those who think differently to oneself on social media. I myself received a barrage of personal abuse (not just disagreeing with me, character attacks) from a fellow health professional on twitter who I do not know, and while I have no issue whatsoever with people disagreeing with me, the manner in which it is done should still be respectful of a colleague, and would open up to more interesting discussion. As a result I now virtually never post anything clinical on twitter for fear of another personal attack. A culture of wariness definitely exists even amongst lecturers at conferences, who anticipate the rude barrage of abuse that is often seen on social media after a lecture. And yet when it is happening to another colleague we all sit back and allow it to take place for fear of them turning on you. We can all disagree on things, and clearly I am sitting centre of one side of the the fence with regards to therapy choices, but just because we have different schools of thought does that make us wrong? My patients get better doing what I do, and yours do too. I love the fact that in my clinic I have ten different therapists who all work really differently to me, should we not be celebrating the different things we can all bring to the table rather than berating those with different philosophies? If we do not start to encourage more open discussions and support one another I am extremely concerned about the future of our profession.